Lamictal ? Since No doctor will call back!!! UPDATE!!

[totoro]

OK, week 3 of no-one returning a call!!! So nice.

Anyway, K is up to 37.5mg of Lamictal once a day in the a.m. she is also taking 2.5mg Abilify bid.

She has been severely depressed, more than ever before, sitting in the a.m. and just staring out the window, "no-one likes me", "I am the worst kid" lots of staements like that, "When I am sad I want to die"
She is also raging again, hitting, biting, tearing apart the room. If I tell her "no" she is falling apart and unable to calm down.

It is like she is not medicated... she is cycling worse, having increased night terrors.
Basically it has been horrible for about 3 weeks now. She has been on the Lamictal since May 19th, so only 19 days. We are going for 50 mg which will be in a couple of days, day 21.
I guess I am wondering if the Lamictal can make her "worse"??? When I told old psychiatrist that she was on Lamictal, her first response was take her off now, that is not a good medication for her... with her symptoms.
So now I am so unsure of what to do, new psychiatrist is SO clueless as to K's true personality or reactions... I called her office again this mornng and pleaded that someone call me back. 2 hours now.

I am just wondering for those of you that have had adverse rxns. to Lamictal, what were they? I know it takes a long time to start working positively, but should I be seing this???
Thanks
Maybe she is just ODD... HA HA

 

[smallworld]

T, I really wish the psychiatrist would call you back . . .

Having said that, K is still on a low dose, and any mood stabilizer like Lamictal can take 6 to 8 weeks at a therapeutic dose to take effect. I honestly don't know if you can judge its effectiveness at this point.

Maybe K is still hearing voices? Is there any way the Abilify can be increased as you wait for Lamictal to take effect?

 

[klmno]

My son was put on lamictol, starting with 25 mg/day, then increased to 50mg/day, then got moodier, very difficult to deal with, and stayed up 36 hours straight then crashed for 16 hours. psychiatrist pulled him off lamictol at that point. I am not suggesting you pull your difficult child without direction from your psychiatrist though.

 

[smallworld]

This is an interesting tidbit from http://www.crazymeds.org:

"Lamictal is also approved to treat Bipolar 1 Disorder, but only if you are already stable on approved medications. That's right, officially you can't start out with Lamictal as your initial treatment for Bipolar disorder. You can add it on to something or convert to it from something else."

I don't know if the above is true, but maybe that's why your old psychiatrist didn't want K on Lamictal? I know that when my kids were rxed Lamictal, they were already on Depakote. We decreased the Depakote and then added in Lamictal. difficult child 1 is still on a lower dose of Depakote, but we finally weaned easy child/difficult child 2 from Depakote completely once she reached her therapeutic dose of Lamictal.

Something to ask a psychiatrist about.

 

[oceans]

Interesting. My psychiatrist wanted to add lamictal to augment antidepressants and prevent my difficult child from a continual downward swing. When we were in the psychiatric hospital, the Dr's there kept saying it would help him from sinking down again once he was already stable. So, maybe there is something to the crazy medications information. It is also difficult to say what would happen once on therapeutic levels, which you are not there yet. Perhaps this is why the other psychiatrist told you the best bet was the Lithium.

 

[totoro]

I had already read the crazymeds stuff before starting her. I had hoped she was "stable" with the Abilify...
I know she is not at a therapuetic level yet and it takes 6-8 weeks once at that level. I am wondering if anyone that has taken it saw an increase in moods while they were waiting for the therapeutic dose to be reached???

If this is a side affect or if this is just her getting worse????

psychiatrist called of course when I was at Occupational Therapist (OT), I left my cell phone #, she did not call that... I called back 4 minutes later... "she is leaving, can I take a message" I am so pissed!!!

 

[DammitJanet]

In my opinion this is an odd reaction to lamictal considering it is supposed to help with the depressive side of bipolar. It could be that it isnt at therapeutic level yet or it could be the wrong medication for her. Problem is you just dont know!

I so wish you had a good childrens mental health hospital near you. I know, you do too.

I dont know if this is anxiety, depression, a medication reaction or a combo of all three. I do hope you can get it resolved though because I can only imagine how heartbreaking it is for everyone.

I am keeping you in my thoughts.

 

[jannie]

I don't know about lamictil, but I know that my child got worse not better while we were increasing trileptal. Have you ever tried increasing the abilify? 2.5 mg is still a pretty low dosage.
I'm sooo sorry your docotor is not calling back...How many messags have you left??

 

[Steely]

What about the Abilify? I know that medication caused my son to become more manic. How long has she been on that?
Not sure about Lamictal - but I know any medication can cause adverse reactions. We had a horrendous one on Trileptal and Abilify, and I could not wait out the 6-8 weeks to get to a therapeautic level without my son being a harm to himself or others.

 

[totoro]

She is actually on 2.5mg bid of Abilify- so 5mg total. She has been on the Abilify since 3/8 we started really low 1mg. Just to avoid reactions. Because she had adverse reactions to Risperdal and Trileptal... We increased from 4mg to 5mg about a month ago.

I am just so frustrated right now...

I just called and cried to my pediatrician... they jut got info on a new psychiatrist at one of the big Hospitals in Spokane... She gave me his number and is going to call him also!!! I begged him on his answering service to take us on.

I just said to the nurse " what do I have to do? This can not be good for my little girl's mind!" " I can not imagine what is going on in her head"
She is running back and forth from room to room, "I'm scared" (she always did that) but it is getting to me, I am so tired of her pain... I just want her to be OK.
Oh joy now the mania is coming, she is screaming and jumping non-stop, touching her sister... all of this in 15 minutes and now we have tears again....
give me strength.

 

[smallworld]

The way I read the crazymeds info is that another mood stabilizer (like Depakote, Lithium or Tegretol) needs to stop the mania first and then Lamictal is introduced to address residual depression. Lamictal is also used to augment antidepressants in the case of refractory depression.

I'm wondering if K's mania is not being touched by the Lamictal. Or the dose is just not high enough to make a difference.

by the way, K's been on Abilify long enough to know if that dose is helping (or causing side effects). You may want to ask about raising it.

T, I sure hope you get in to see a psychiatrist soonest.

 

[totoro]

Smallworld- thanks
I asked about the Lamictal... "It should be fine" was the response... I to was worried about the, Crazymeds info about needing to be stabilized prior to starting...
But what do I know???
I am waiting for pediatrician now to call back and ask her about raising the Abilify... since psychiatrist can't return a call...

Of course I was trying to be nice and fill my mother in law in on what was going on, "We will get through this, whatever we have to do to get that child help we will do"

I am thinking who is this "WE"... They think buying her stuff and giving in to her every whim will make it all just go away... I think they still secretly hope we are wrong. If for one minute they accept the diagnosis then they are giving in to it, "Not being positive".

 

[smallworld]

T, I have a mother in law like your mother in law. When husband and I told her about difficult child 1's suspected diagnosis of BiPolar (BP), she didn't believe it. She kept asking whether the medications were making him worse and whether we should take him off everything (she hates ALL medications). Yeah, right, the mood stabilizers were making him better, not worse. She kept saying, "Are you sure? Couldn't it be the environment?" Blaming her own son and daughter in law for causing BiPolar (BP)!!! She could not possibly wrap her head around the fact that Zoloft had caused a manic reaction in her grandson. Furthermore, she doesn't even ask about my girls because boys are better than girls. REALLY!

We don't tell her anything anymore. In fact, when the phone rings on Sunday morning -- the only time mother in law and father in law call -- I have husband answer it. I know it's horrible of me, but months go by before I talk to them.

Hope you reach the pediatrician tonight. Hang in there.

 

[pepperidge]

Hi

i Have one child who went on Lamictal, who was very irritable (made worse by Prozac and also to an extent Adderall). He didn't do well on anything else, but Lamictal has really helped his irritability/depression. He was not really manic ever though (except maybe when on Prozac). And Adderall has actually also been a godsend for him as well.

My other child also not typical bipolar has found Abilify really helpful for impulsiveness etc. He can't do stims at all. We tried Lamictal since he was still having lots of issues iwth emotional disregulation. Lamictal might have made him marginally more irritable, but didn't seem to have helped. We have also tried about 12 other medications but not seem to have helped. Jury is still out on Trileptal.

neither had negative reactions at all to Lamictal as we were titrating up.

How long as she been off the Risperdal? Maybe it was helping her more than you think, and the Abilify hasn't kicked in enough. Lamictal seems a rather curious choice since your daughtr seems also to be quite manic as well.

I really feel for you on the psychiatrist front. I almost wish for all your sakes that you could get her into a really really good psychiatric hospital and get her stabilized there.

As I am sure you are already figuring out, even being in a big city it can be hard to find a good psychiatrist, so don't beat yourself up too much about living in the boonies.

keeping my fingers crossed for you.

 

[Sara PA]

I think the guy at crazymeds is a bit off in his comments. From the Lamictal prescribing information:

Bipolar Disorder: LAMICTAL is indicated for the maintenance treatment of Bipolar I Disorder to delay the time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in patients treated for acute mood episodes with standard therapy. The effectiveness of LAMICTAL in the acute treatment of mood episodes has not been established.

"Maintenance treatment" is the term used to mean what we usually call "mood stabilizer" to differentiate it from those medications like the antipsychotics which treat the acute phases. There is no reason, officially or otherwise, that you can't start out on Lamictal. It may not help an acute phase but then we know Lamictal, like the other mood stabilizers, take a while to work. That's why doctors often prescribe the APs for acute manic phases and, even though they shouldn't, antidepressants for the acute depressive phases.

 

[crazymama30]

My difficult child responded poorly to Depakote and Lithium, but does good with Lamictal and (cross fingers) Daytrana. Lamictal was the only thing that touched his irritablity. Depakote and Lithium increased it, and increased his aggression. Hugs, and good vibes your way. I am with dammit janet, I wish you had better mental health care

 

[DammitJanet]

You know Sara...it almost sounds like this child might be cycling so rapidly she is triggered into mixed states. I do that on occasion.

Totoro, has she been on any cold medications recently? I was triggered into a really bad mixed state by a steroid shot.

 

[totoro]

Janet- No cold medications, she was on one day of claritin. But she was bad prior to this and after...

Her first psychiatrist said she was an Ultra-ultra-rapid cycler... just constantly going all day. She manages to hold it somewhat together at school, but has yet to be in a structured environment!!! No desks yet.

I think she is constantly in a mixed state, i can feel myself turn at times but it has never been anything close to what she does!!!

She takes fish-oil and flouride pills and that is it besides her medications.

Her therapist is coming tomorrow to the house, for the first time!!! I may push for once a week instead of every other week. If she feels she can help at all.

Well I will start all over again in the morning... back on the phones... JOY

Thanks everyone

 

[smallworld]

My bad -- I'm sorry! I don't think I'll be quoting from crazymeds again . . .

 

[DammitJanet]

Do you have any idea how high they intend to go on the lamictal? I know you are aiming for 50 in the next week or so.

When are you moving?

I know she is on abilify and she bombed on risperdal but have you ever tried seroquel? I know, I know you dont even want to go there with trying a different AP but if the abilify isnt holding the mania at all maybe consider it?

Im just tossing things out.